Recent court rulings show that motor insurance fraud is no longer only being tried by organised schemers. Increasingly, people with no previous criminal record are also trying their luck, but end up with a criminal conviction instead of the insurance indemnity they hoped to get.

Insurance fraud can sound like a crime series, with professional criminals, staged accidents and elaborate scams cleverly intertwined. The reality, however, is much more sinister, according to Oleg Gusseletov, Head of the Prevention and Investigation Department at Seesam.

“In addition to organised and experienced scammers, we’re seeing more and more cases of people without any previous history of offences trying their luck,” said Gusseletov. “They often think that bending the truth a little in a claim notice or in the circumstances of the case is nothing serious. Actually, submitting false information knowingly can lead to criminal proceedings.”

Smaller attempts at fraud on the rise

Last year, motor insurance fraudsters tried to swindle half a million euros from Seesam. The largest of these fraud attempts amounted to €50,000. Cases where Seesam’s insurance investigators identified signs of a crime were passed on to the police.

According to Gusseletov, the increase in insurance fraud in recent years is reflected in smaller and more frequent fraud attempts. An increasing number of attempts is made to change or doctor insurance claim documents, including invoices, price quotes and other supporting materials.

“Artificial intelligence is used increasingly more to change documents, but fraudsters are not the only ones who can use various modern tools,” said Gusseletov, who has experience in police work. “We give a lot of attention to the development of technical capabilities that allow us to carry out research more efficiently. However, our work is not limited to checking paperwork. If necessary, we will visit the scene, talk to the parties, interview witnesses and check video recordings, vehicle movement data and other facts that the person trying to defraud may not notice or consider important.”

And the submission of false information does not always stay on the insurance file alone. This is also shown by recent court rulings.

Insurance in the afternoon, “accident” in the evening

On the last day of April, two men accused of a staging a road accident in Narva were sentenced.

According to the indictment, a mandatory motor insurance policy was taken out for a Peugeot 607 car at 14:58 on 26 June. In the evening of the same day, shortly after ten o’clock, there was an alleged collision with a BMW X5 at a junction.

The version presented to the insurer sounded ordinary at first glance: the car coming from the side road did not give way to the vehicle on the main road.

“However, both the expert commissioned by the insurance company and the traffic expert confirmed that at the time of the collision the BMW was stationary and the Peugeot was travelling at around 55 km/h. The version presented by the drivers was not technically possible,” said Gusseletov.

The court found both men guilty of insurance fraud. Instead of earning the €4,000 they had hoped for, both men were sentenced to two years of suspended imprisonment with a probationary period of 2.5 years. In addition, they have to compensate the insurer for the damage suffered and pay almost €10,000 in legal costs.

It is not worth risking fraud to repair previous damage

Another recent court ruling concerns a case where the insurer was presented with a version of an ordinary road accident, but the vehicle’s own technical data contradicted this.

According to the court materials, the driver of the Lexus claimed to have driven in front of a Volkswagen travelling on the main road at an intersection in Pärnumaa. According to her, she spotted the other car, braked but was unable to avoid the collision.

“In fact, at the time of the collision, the car was in neutral, travelling at zero kilometres per hour and the brake pedal had not been pressed before the collision. In addition, the vehicle was found to have previous unrepaired damage and a breakdown that had occurred before the accident in question,” said Gusseletov, sharing the findings of the investigation.

The court found the woman guilty of insurance fraud. In addition to six months of suspended imprisonment, she has to pay more than €1,800 in legal costs and compensate the insurer for the damage caused.

According to Gusseletov, insurance fraud does not always mean an organised scheme or a staged massive accident. Even a seemingly small lie can turn into a criminal case if facts, technical data and other evidence tell a different story. “However, most people are honest and that’s why we conduct investigations carefully and only when there is a real basis for doing so,” the insurer explained.